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REGUB Path - Benign Breast Disease (ii) (Pathological dx (FNAC (not method…
REGUB Path - Benign Breast Disease (ii)
Pathological dx
FNAC
not method of choice
solid + cystic masses
quick
aspiration, spread onto slides, staining, interpretation
no anaesthetic
in OPD
cost effective
operator dependent - expertise needed
needle core bx
guns - thin cores of tissue
requires local anaesthetic
slower
easier to interpret
distinguishes in situ from invasive
open bx
if uncertainty following triple assessment (not all elements of assessment in agreement)
possibility of intra-op frozen section
dx categories
1 - inadequate
2 - benign
3 - lesion of uncertain malignant potential
4 - suspicious
5 - malignant
Inflamm conditions
acute mastitis
cracked nipple during lactation allows bacteria (S aureus > strep) to invade breast parenchyma
fever, erythema, pain, purulent nipple discharge
tx: antibiotics, rarely surgical drainage
chronic inflamm
scarring
may mimic malignancy
periductal mastitis
occurs when ducts (tubes) under nipple become inflamed + infected
a/w smoking (vit A deficiency)
squamous metaplasia of ducts -> keratin production -> plugs duct + causes inflamm
painful subareolar mass
inverted/retracted nipple (due to fibrosis)
inflamm cells - granulomatous inflamm
tx = surgical excision of involved duct
mammary duct ectasia (aka ecstasis)
dilation/distention of tubular structure
occurs mostly in 5th + 6th decades
poorly defined palpable periarealar mass with thick green/brown nipple discharge
can mimic carc clinically + on mammogram
inflamm + dilation of subareolar ducts
inspissated (thick) secretions in large ducts - plug ducts + 'spill' into surrounding stromal tissue - chronic inflamm with plasma cells +/- granulomas
fat necrosis
usually follows trauma (may be iatrogenic - surgical bx)
risk factors: obesity, post-menopausal
present as mass on exam or calcification on mammography
bx shows necrotic fat, calcification + giant cells (foamy macrophages)
granulomatous mastitis: idiopathic or a/w systemic granulomatous disease (e.g, sarcoidosis)
lymphocytic mastitis
often a/w insulin dependent T1DM (DIABETIC MASTOPATHY)
palpable mass
usually subareolar
often bilat
Galactocoele
cystic dilation of duct during lactation
may become infection (acute mastitis) with abscess formation
Clinical significance of benign epithelial changes
non-prolif: no increased risk of breast carc
prolif (no atypia): mild carc risk (x1.5-2)
prolif with atypia: moderate carc risk (x4-5)
Gynaecomastia
enlargement of male breast
unilat in 70%
oestrogen excess
cirrhosis
puberty
testicular tumours
drugs
spironolactone
chlorpromazine (anti-psychotic)
cimetidine (H2 blocker)
androgens
alcohol
marijuana
heroin